Nutrition

UNIT 5 FOOD BORNE DISEASES AND

FOOD SAFETY
Structure
5.0 Introduction
5.1 Objectives
5.2 Food Borne Diseases
5.2.1 What is Meant by Food Borne Disease?
5.2.2 Burden of Food Borne Diseases
5.2.3 Causes and Classification of Food Borne Diseases
5.2.4 Signs and Symptoms of Food Borne Diseases
5.2.5 Transmission of Food Borne Pathogens and Toxins
5.3 Food Poisoning and Food Intoxication
5.3.1 Epidemiological Features/Clinical Characteristics
5.3.2 Types of Food Poisoning
5.3.3 Food Intoxications – Features, Preventive and Control Measures
5.4 Public Health Response to Food Borne Diseases
5.5 Food Safety
5.5.1 What is Food Safety?
5.5.2 Food Safety Considerations and Measures
5.5.3 Food Safety Regulatory Measures in India
5.5.4 Five Keys to Safer Food
5.6 Food Storage, Food Handling and Cooking
5.6.1 General Principles of Food Storage of Food Items
5.6.2 Role of Food Handlers in Food Borne Diseases
5.6.3 Essential Steps in Safe Cooking Practices
5.7 Let Us Sum Up
5.8 Model Answers
5.9 References

5.0 INTRODUCTION
In the previous unit, you have learnt about nutritional deficiency disorders. In
India, the concept of food safety is now being considred seriously. The current
initiative of ‘Swachchh Bharat Abhiyaan’ by the Prime Minister Shri Narender
Modi will also benefit the cause of food safety in times to come. Actually the
focus of safety must be on entire supply chain production, processing, distribution
and marketing.
We often think that home cooked food is always safe, this is a wrong perception.
If adequate care is not taken, even home food can also get contaminated. Of
course, it is correct to assume that food taken outside home is more likely to be
unsafe and contaminated. Actually, food safety can be compromised at any stage
from farm (where food is grown) to fork (when it is consumed). Food can easily
become unsafe when we do not follow hygienic principles during its transport,
storage, cooking, and serving of food. Safe food does not cause any harm to
106 whosoever consumes it.
In the previous units you have learnt different aspects of food and nutrition. Food Borne Diseases and
Besides being essential for health and survival food also causes many diseases. Food Safety
This includes food borne infections and food poisoning. It may manifest as
mild infections to severe disease. These illnesses may even lead to death and
disability if not identified early and treated properly. You may also encounter
in your field service area outbreaks of such diseases, particularly of food
poisoning.
In this unit you will learn how food transmits many diseases; what are the various
food borne diseases and how these manifest. You will also learn how to recognise
the food borne illnesses including their severity and to take preventive and control
measures. In addition, you will also learn components of food safety and how to
make people aware about food safety problems.

5.1 OBJECTIVES
After completing this unit, you should be able to:
• describe the burden of food borne diseases and their consequences;
• recognise, assess and classify different food borne diseases;
• explain modes of transmission of food-borne pathogens and toxins;
• investigate food poisoning cases/outbreaks;
• describe preventive and control measures for food borne diseases;
• identify the signs and symptoms of food poisoning and refer for management;
• define food safety;
• identify the measures to be taken at various levels to ensure food safety;
• make people aware about practicing Five Keys to Safer Food; and
• describe the food storage, food handling and cooking.

5.2 FOOD BORNE DISEASES

Food borne diseases encompass a wide spectrum of illnesses and are growing
public health problem worldwide. Let’s discuss in detail about the food borne
diseases.

5.2.1 What is Meant by Food Borne Disease?

These illnesses result from ingestion of food contaminated with microorganisms
(bacteria, viruses, parasites etc) or harmful chemicals (toxins). The contamination
may occur at any stage in the process from food production to consumption. This
may result from unhygienic food handling practices or environmental conditions
including pollution of water, soil etc.
The terms ‘food borne illnesses’ and ‘food borne diseases’ (FBD) are generally
used interchangeably. In this module, we shall use the term FBD to denote both.
In most cases isolated episodes of such diseases occur. Outbreaks of CBD's are
also frequent when two or more cases of a similar illness resulting from ingestion
of a common food. 107
Nutrition 5.2.2 Burden of Food Borne Diseases
Borne Diseases are a major public health problem worldwide. The causal
relationship between food contamination and resulting illness or death is difficult
to establish. Food hence, most such diseases are not reported.
• Unsafe food containing harmful bacteria, viruses, parasites or chemicals,
causes more than 200 diseases – ranging from diarrhoea to cancers.
• An estimated 600 million – almost 1 in 10 people in the world – fall ill after
eating contaminated food and 420 000 die every year.
• Children under 5 yrs age carry 40% of FBD burden.

5.2.3 Causes and Classification of Food Borne Diseases

Causative agents for food borne diseases are many. Some of the common agents
associated with food borne diseases are as follows:

Bacteria: Salmonella, Campylobacter, Escherichia coli, Vibrio cholera,

Listeria, Staphylococcus, Clostridium perfringes and botulinum, Bacilus cereus
etc.
Virus: Norovirus, Rotavirus, Hepatitis A and E virus etc.
Parasites: Entamoeba histolytica, Giardia lamblia, Cryptosporidium, Fish-
borne trematodes, Echinococcus spp, Taenia solium/saginata, Ascaris
lumbricoides etc.
Toxins: Mycotoxins (e.g. aflatoxins), Marine biotoxins, Mushroom toxins,
Shelfish toxins, Plant toxicants etc.
Chemicals: Pesticides, Polychlorinated biphenyls (PCBs), Heavy metals (lead,
cadmium, mercury, copper etc.), Nitrites etc.

Classification of Food Born diseases:

In general the FBD are classified into two groups:
a) Food-borne infections: caused by microorganisms
b) Food-borne intoxications: caused by toxins and chemicals
Food poisoning as a clinical entity belongs to both food borne intoxications
and food borne infections; in this unit, food poisoning will be described
separately.

5.2.4 Signs and Symptoms of Food Borne Diseases

Different causes present with different symptoms, so there is no single syndrome
that can be labelled as FBD; however, common symptoms include:
• Abdominal cramps, diarrhoea (which may be bloody), nausea, vomiting, fever,
headache, fatigue, and body aches. All of us must have experienced these
symptoms sometimes or other.
• Signs and symptoms may start within hours after eating the contaminated
food, or they may begin days or possibly even weeks later. But we may not
link these to unsafe food taken by us. Quite often we overlook and ignore
108 mild FBD.
• Less commonly, neurologic symptoms may develop, such as blurry vision, Food Borne Diseases and
dizziness or tingling in the arms. Food Safety

• In some instances, the most life-threatening problems occur several days

after the start of intestinal symptoms. These can include kidney failure, pain
and swelling of joints and paralysis that can plague victims for the rest of
their lives. We feel that these are a part of our routine lives. Many people are
not aware that unsafe food may also cause diseases like jaundice, typhoid
etc.
The capacity to tolerate FBD varies from person to person. Some may become ill
after ingesting only a few harmful bacteria; others may remain symptom free
even after ingesting thousands.
It depends upon the age, physical condition (pregnancy) and any existing
disease. Chemical agents in food, such as pesticides can cause neurological
symptoms, burning sensations in the chest, neck and abdomen. Some
chemicals are extremely poisonous and if ingested may result in severe
vomiting within a few minutes. Consumption of these chemicals over a long
duration can cause cancer, birth defects damage to the nervous, reproductive
and immune system. Toxic metals in food if ingested in sufficient quantities
can cause metallic taste in mouth, vomiting and abdominal pain, usually within
a few hours.
In modern times, increase in variety of foods along with the eating out culture
has predisposed the consumers to hazards related to unsafe food. It is difficult to
assure the safety of a food item which has travelled miles before reaching our
table or has been handled by people in eating establishments. It may be
contaminated with harmful chemicals, pesticides, antibiotic residues, pathogenic
microorganisms etc. Hence, consumption of contaminated such food may cause
FBD. Food safety may be compromised even through kitchen equipment,
surroundings, improper waste disposal and unclean water.
Differences between Food-borne Infections and Intoxication

Infections Intoxication

Cause Bacteria / Viruses /Parasites Toxins/Chemicals

Mechanism Invade and / or multiply within No invasion or multiplication

the lining of the intestines

Incubation period Hours to days Minutes to hours

Symptoms Diarrhoea, Nausea / Vomiting, Vomiting, Nausea, Diarrhoea,

Abdominal cramps and/or Double vision, Weakness
Fever Respiratory failure, Numbness,
Sensory and motor dysfunction

Transmission Can spread from person-to- Not communicable

person via the faeco-oral route

Factors for food Inadequate cooking, Cross- Inadequate cooking, Improper

contamination contamination, Poor personal holding temperatures
hygiene, Bare hand contact

109
Nutrition You need to suspect and identify FBD and take measures for control and
prevention.

5.2.5 Transmission of Food Borne Pathogens and Toxins

Food may become contaminated during production and processing, during food
preparation and handling or due to improper storage. (Fig. 5.1)
Mishandling of food has been implicated in 97% of all FBD. However, it is
preventable through proper implementation of food safety measures and strict
enforcement of food hygiene.

Food handler (Case / Shedding typhoid Visits toilets,

carrier) Typhoid
 bacilli in faeces and urine  contaminates hands


Resumes work with
Infected food consumed Does not wash his
 contaminated hands;
without any heating  hands/ incorrect washing
transmit pathogens to
Technique (without
food and make it infected
soap)


like salad, cream

Consumer gets infected
and suffers FBI

Fig. 5.1: Example of how FBD spread from Food handlers to Consumers

Food production and processing

Foods, such as fruits and vegetables, may be contaminated if washed or irrigated
with water that is contaminated with pathogens from animal or human faeces.
Animals naturally harbour many food-borne bacteria in their intestines that can
cause illness in humans. But often these do not cause illness in the animals.
During slaughter, meat and poultry carcasses can become contaminated if they
are exposed to small amounts of intestinal contents.
Food preparation and handling
• Infected individuals – Most food-borne pathogens are shed in the faeces
of infected persons. These are then transferred to others through food
via the faecal-oral route. Bacteria present in infected lesions and our
nose may also be transmitted from an infected food-handler to ready-to-
eat foods.
• Cross-contamination – Pathogens present in one food may be transferred
to other foods during cooking if same equipment and utensils are used
without washing and disinfecting, especially in case of ready-to-eat
foods.
• Inadequate cooking temperature – With insufficient cooking bacteria can
multiply and produce toxins within the food. Many bacterial toxins are
heat stable and may not be destroyed by cooking. This is particularly
true for ‘re-heating’ of stored food (more so for Non-Veg. items)
Food storage
Food held or stored at more than 25ºC to 60ºC) temperature allows multiplication
of pathogens. It is an important cause of food-borne outbreaks.
110
 Food Borne Diseases and
Check Your Progress 1
Food Safety
1) What proportion of Food Borne Diseases is constituted by children under
5 years of age?
................................................................................................................

2) What are the two major types of food borne diseases?

................................................................................................................

3) Enlist the causative agents for food borne diseases.

................................................................................................................

4) List the common signs & symptoms of food borne diseases.

................................................................................................................

5.3 FOOD POISONING AND FOOD

INTOXICATIONS
Now we will discuss about Food Poisoning and Food Intoxication, which shares
a large portion of the burden of food borne diseases.

5.3.1 Epidemiological Features / Clinical Characteristics

Food poisoning is an acute inflammatory disease of the gastrointestinal tract. It
is caused by the ingestion of food contaminated with toxin producing bacteria,
their pre-formed toxins, chemical substances or other poisonous substances. Food
poisoning is very common. More than 10 million cases occur in India per year.
You might have heard of various food poisoning outbreaks.
Some incidents drawn the attention in recent years are discussed here.
An outbreak of Staphylococcal aureus food poisoning due to contaminated
“bhalla” (a snack made up of urad dal balls fried in vegetable oil) affected more
than 100 children and adults in Madhya Pradesh in 2007. An outbreak of food
poisoning due to epidemic dropsy (mustard oil contaminated with argemone oil)
was reported from Delhi in 1998 in which 60 persons lost their lives and more
than 3000 cases were hospitalised. These are just two examples. Such out breaks
keep on occurring.
Following news cuttings describe the recent ‘Bihar midday meal tragedy’. It may
give you an instant look over the severity of the case.

Bihar midday meal tragedy:

“On 16 July 2013, children aged between four and twelve years at primary
school complained that their lunch, served as a part of the Midday Meal
Scheme, tasted odd. Children who questioned the food were rebuked by the
headmistress. Earlier, headmistress Mrs. Kumari had been informed by the
school’s cook that the new cooking oil was discoloured and smelled odd.
Kumari replied that the oil was purchased at a local grocery store and safe to
use. The cook, who was also hospitalised by the poisoning, later told reporters
111
Nutrition
that it looked like there was “an accumulation of residual waste at the bottom
[of the oil jar]”. The meal cooked at the school that day consisted of soya
beans, rice and potato curry. Thirty minutes after eating the meal the children
complained of stomach pain and soon after were taken ill with vomiting and
diarrhoea. The number of sick children overwhelmed the school and local
medical system.
Some of the sick children were sent home, forcing their parents to seek help
on their own. According to the official count, 23 children died as a result of
the contaminated food. Parents and local villagers said atleast 27 had died.
Sixteen children died on site, and four others were declared dead upon arrival
at the local hospital. Others died in hospital. Among the dead were two children
of a female cook, Panna Devi; her third child survived. A total of 48 students
fell ill from the contaminated food. Three remained in a critical condition as
of 17 July. Thirty-one children were moved from the local hospital to the
Medical College Hospital for further treatment.
Initial indications were that the food was contaminated by an organophosphate,
a class of chemicals commonly found in insecticides. A local government
administrator commented “It appears to be a case of poisoning but we will
have to wait for forensic reports. Had it been a case of natural food poisoning,
so many children would not have died.” As per Hospitals authorities the
survivors were emitting toxic vapours, which led his team to suspect almost
immediately that they had been poisoned by an organophosphate.
Late on 17 July, officials stated that they believed the cooking oil had been
placed in a container formerly used to store insecticides. According to state
officials, the school’s headmistress had bought the cooking oil used in the
food from a grocery store owned by her husband. On 20 July police said that
a forensic report confirmed the cooking oil contained “very toxic” levels of
‘monocrotophos’, an or anophosphate in Secticide pesticide.”
This news story may have given you a glimpse how the food poisoning can
be so disastrous.

You can identify the food poisoning cases based on the following epidemiological
features characteristics:
• History of ingestion of common food (as in family functions, hostels/hotels
etc)
• A group of persons being affected simultaneously
• Similarity of signs and symptoms in the majority of cases
• Common symptoms are vomiting, diarrhoea, pain in the abdomen, fever etc.
• Short incubation period
• Absence of secondary cases
• Laboratory tests are rarely required

5.3.2 Types of Food Poisoning

a) Bacterial food poisoning:
This is caused by taking contaminated food. It may be –
112
Infective: Organism enters the body through the food, produce toxin, cause Food Borne Diseases and
pathology and result in clinical manifestations, e.g., Salmonella,Clostridium Food Safety
perfringes, Vibrio parahaemolyticus OR
Toxic: Due to already formed toxin in the food, e.g., Staphyloccus aureus,
Clostridium botulinum, Bacillus cereus etc.
b) Non bacterial food poisoning:
Chemical poisoning: Due to pesticides, arsenic, mercury etc.
c) Certain plants and sea foods: Due to mushrooms, solanine (green potatoes)

Common bacterial food poisoning: source / common foods and clinical

features:
Cause Source / Common Foods Clinical Features
Salmonella Man gets infection from animals Sudden onset with chills,
food poisoning and poultry. Contaminated major fever, nausea, vomiting
foods - meat, milk and milk and profuse watery
products, sausages, custards, egg diarrhoea, may be
and egg products. Food contami- associated with blood.
nated with urine of rats and mice
is also responsible.
Staphylococcal Cutaneous infections (boils, Sudden onset of vomiting,
food poisoning carbuncle etc) of human and severe and violent is the
animals (particularly cows). main feature. Abdominal
Foods involved - salads, cramps and diarrhoea also
custards, milk & milk products occur, but rarely fever.
etc.
Botulism Soil and dust and the intestinal Major symptoms- dysphagia,
tract of animals. Foods mostly diplopia, ptosis, dysarthria,
responsible – home-canned blurring of vision, muscle
vegetables, smoked or pickled weakness, quadriplegia.
fish, home-made cheese etc. Gastrointestinal symptoms
very slight, no fever.
Cl. perfringes Dust and soil is the reservoir Moderate diarrhoea with
food poisoning of spores. Reheating the stale nagging abdominal pain
cooked foods (meat, poultry) and prostration. Nausea/
prior to consumption is the vomiting and fever rarely
critical factor. occur.
B. cereusfood Soil and food grains mainly Manifests in two forms –
poisoning cereals (raw, dried and pro- emetic form with symptoms
cessed). Cereal based diet – like staphylococcal food
spores can survive cooking poisoning and enteric form
and germinate and multiply with symptoms like Cl.
in favourable temperature. perfringes food poisoning.

5.3.3 Food Intoxications – Features, Preventive and Control

Measures
Besides food poisoning, other commonly occurring intoxications are of two
categories: 113
Nutrition a) Due to naturally occurring toxins in the food grains: Lathyrism, Epidemic
dropsy, Endemic ascites, Toxic polyphenol etc.
b) Due to toxins produced by the fungi in the food grains: Aflatoxicosis,
Ergotism.

Characteristic features and common food grains involved in intoxications

Food Toxins and Foods Involved - Preventive and Control
Intoxications Characteristic Features Measures
Lathyrism Consumption of the pulse - Health Education on dangers
lathyrus sativus (‘Kesari dal’) of consuming this pulse
which contains the toxin - Beta Removal of toxin by soaking
oxalyl amino alanine (BOAA). the pulse in hot water
Neurolathyrism affecting nervous (steeping method) and
system, gradually developing parboiling Vitamin C
paralysis of legs. Manifest in prophylaxis. Banning the crop
stages-latent, no-stick, one- and/or selective cultivation of
stick, two-stick and finally pulse strains with low levels
crawler stage. of toxin.
Epidemic Contamination of mustard oil Ensuring supply of pure
dropsy with argemone oil containing mustard oil by strict enforce-
a toxic alkaloid, sanguinarine. ment of laws. Avoiding the
Argemone seeds closely use of mustard oil altogether
resemble mustard seeds and when the disease is prevalent
contamination may be acci- in the locality
dental and deliberate.
The symptoms consist of Health education about
sudden, non-inflammatory, argemone seeds and oil;
bilateral swelling of legs, often removing argemone weeds
associated with diarrhoea. growing among oil-seeds
Dyspnoea, cardiac failure and crops.
death may follow.
Nitric acid test and Paper All packed cooking oils may
chromatography for detection have a label ‘Argemone Free’.
of argemone oil.
Endemic The millet Panicum miliare Educating the people in the
ascites Locally known as Gandhte affected area, Deweeding of
contaminated with seeds of the Jhunjhunia plants which
Crotalaria (locally known as grow along with the staple
Jhunjhunia), which contain Simple sieving of the millet
hepatotoxins – pyrrolizidine at the household level to
alkaloids. remove the seeds of
Manifests with rapidly deve- Jhunhunia.
loping ascites and jaundice
Aflatoxicosis Fungi Aspergilus flavus, Proper storage of food grains
parasiticus infests food grains in dry containers, moisture
such as ground nut, maize, content should be below 10
parboiled rice, sorgum, wheat, per cent.
114
 Food Borne Diseases and
rice, tapioca under conditions Not to consume fungi
Food Safety
of improper storage and produce contaminated food grains.
Aflatoxins.
Characterised by hepatitis, Health education to the local
cirrhosis of liver, and/or people about health hazards.
enteritis.
Ergotism The ergot fungus, claviceps Removal of ergot infested
fusiformis infests food grains grains by floating in salt
such as bajra, rye, sorgum and water, hand-picking or air
wheat during flowering stage. floatation.
Symptoms are acute but rarely
fatal; includes – nausea, repea-
ted vomiting, giddiness, drow-
siness.

5.4 PUBLIC HEALTH RESPONSE TO FOOD

BORNE DISEASES
As a nurse you may encounter food borne diseases / poisoning cases or outbreaks.
Here your tasks would be:
• Early detection, management and referral: Identify the cases and assess
for severity. Refer the severe cases urgently to health centre for proper
management. Most such cases are mild, self-limiting and resolve without
treatment. Assure and help patients accordingly. Ensuring hydration is the
mainstay of treatment. Focus on assessment and reversal of dehydration,
through ORS or IV fluids in serious cases.
• Reporting of any case /outbreak and investigation: Inform any case/
outbreak immediately to higher level as per the existing programme/project
(e.g. IDSP) guidelines. Outbreaks of food poisoning need to be investigated
by a team and take part in such investigations (as has been discussed elsewhere
in other units). Investigations will help to identify appropriate control and
preventive measures.
• Health Education: Educating people about reservoir/source of contamination
and transmission, common foods involved, signs/symptoms and danger signs,
personal hygiene and food hygiene. Most FBD are preventable by simple
behavioural changes. Emphasising the measures for prevention and control
including food safety is an appropriate response.

Check Your Progress 2

1) Which is not an epidemiological feature of food poisoning?
a) Group of persons being affected simultaneously
b) Similar signs and symptoms
c) Secondary cases are common
d) Short incubation period
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Nutrition
2) Outbreak of epidemic dropsy may occur due to contamination of which
food item and with what?
3) Khesari dal (Lathyrus sativus) is associated with which food
intoxications?
................................................................................................................
4) Canned food is mostly associated with which bacterial food poisoning –
a) Salmonella
b) Staphylococcal
c) Botulism
d) Bacillus
5) Mention four common symptoms of food-borne infections.
................................................................................................................
6) What are the levels in the food chain when food can be contaminated?
................................................................................................................

5.5 FOOD SAFETY

We shall now discuss about the food safety, regulatory measures and the key
points to have a safer food.

5.5.1 What is Food Safety?

Food safety describes handling, preparation, and storage of food in ways that
prevent FBD. The main idea is a concept of defence to prevent harm to the
consumers. Unsafe food poses health threats; endangering everyone. It creates a
vicious cycle of illness and malnutrition. Worldwide the importance of food
safety has long been recognised and various measures/initiatives undertaken.
Today food safety is a public health priority both in developed and developing
countries.

5.5.2 Food Safety Considerations and Measures

As you know, food can be contaminated at any point of production,
distribution, handling/ preparation and consumption. So, responsibility also
lies with concerned people involved at different levels for making food safe.
Policy makers, food handlers and consumers can contribute to ensure food
safety:
• Policy making/administrative level: This role is of the government. It
includes developing policies and regulatory frameworks (Laws, Acts etc);
establishing and implementing effective food safety systems (e.g. laboratories,
monitoring and surveillance etc) to respond to and manage food safety risks
along the entire food chain; fostering collaboration among health and other
sectors; etc.
• Food handlers and consumers level: Both need to be aware about the
common hazards linked with the food they use; handle and prepare food
116 safely, practicing the WHO Five Keys to Safer Food at home, or when selling
 at restaurants or at local markets; grow fruits and vegetables using the WHO Food Borne Diseases and
Five Keys to Growing Safer Fruits and Vegetables to decrease microbial Food Safety
contamination etc.
• A new era in food safety has been initiated by formulation of the Food Safety
and Standards Act (FSSA) 2006. While eating our favourite panipuri / puri
bhaji / Pao bhaji with the street vendor we tend to overlook hygiene. However,
the government has included even the small vendors selling food items under
the purview of this Act.
• The Act established a new national regulatory body, Food Safety and Standards
Authority of India (FSSAI), to develop science based standards for food and
to regulate and monitor the manufacture, processing, storage, distribution,
sale and import of food so as to ensure the availability of safe and wholesome
food for countrymen.
• The main intent of this endeavour was to ensure availability of safe and
wholesome food for human consumption. The food manufacturers,
suppliers, vendors, eateries, storage, distribution, imports and exports,
food services and other related businesses would now be governed by
new rules under Food Safety and Standards Regulations (FSSR) 2011.
12th five year plan (2012–2017) also emphasised strengthening of food
safety systems.
• Here, it is important to understand that any law is framed with a view to
improve the quality of life in society. It is always made keeping in view the
future of society. The real impact of any law takes time to show. It is often
said that it takes about fifty years after any legislation to bring about any
worthwhile intended change in society. Hence, despite the formulation of
FSSA 2006, the present status of food hygiene in eating establishments in
India is dismal. However, the process has started. Sooner or later, all the
Eating Establishments in India will have to comply with the prescribed
standards of FSSR 2011.
• Another menace in our country jeopardising food safety is that of Food
Adulteration. This is done by perpetrators at various levels, e.g., producers/
manufacturers, Food Business Operators (FBO), grocery merchants for petty
monetary gains. Food is adulterated, if there is evidence of substandard quality/
substitution by cheaper substance/abstraction of any constituent of article/
preparation or storage in unsanitary conditions/presence of poisonous
ingredients, use of colouring agents/preservatives above prescribed limits/
quantity or purity below the prescribed standards.
• For example, most of the country milk is adulterated with products. The
culprits use fertilizers, bleaching and detergents to thicken the milk and give
it a frothy appearance. Milk adulteration also involves adding water and
removing fats from milk. Often adulterants like starch, wheat flour are added
to milk. This lowers the nutritional content of milk and makes it even unfit
for consumption. Food can also get adulterated unintentionally due to
inappropriate food handling. This includes use of pesticides and fertilizers
during farming or harvesting or improper storage, processing, packaging and
transportation methods. The impact of food adulteration is grievous as it
affects the finances as well as health of people.
117
Nutrition Specific checks required for Food Adulteration are given in the following tables –
5.1a, 5.1b, 5.1c, 5.1d, 5.1e.
Table 5.1 (a): Specific check for procurement of rice and tins

Table 5.1 (b) : Specific check for procurement of pulses

118
 Food Borne Diseases and
Black Food Safety
lentil

Chick
peas

Table 5.1 (c): Specific check for procurement of spices

Table 5.1 (d) : Specific check for procurement of bread and cheese

119
Nutrition Table 5.1 (e): Specific check for procurement of non vegetarian food items

 Food safety is essentially an issue of prevention. For ensuring food safety,

basic hygiene and cleanliness in manufacturing units or kitchens can
immensely contribute towards food safety. Good infrastructure with adequate
lighting, ventilation, hand washing and toilet facilities for food handlers,
adequate and clean storage facilities, clean and maintained equipment and
utensils etc. are the most important factors that facilitate food safety. If kitchen
has good food storage facilities, clean water supply, if food handlers are
healthy, if for public eating establishments good standard are maintained
food safety can be, more or less, taken for granted.
 Under FSSA 2006, it is mandatory to get a license for any food business.
 However, new law alone cannot ensure food safety. The need of the hour is
also to have an integrated approach to change the mind set of people.

5.5.3 Food Safety Regulatory Measures in India

Government of India is also committed to ensuring food safety. There has been
relevant policies/programmes and projects incorporating the issues of food safety.
Several acts and regulations were also in place since long. Currently the entire
120 issue of food safety is being re-emphasised and strengthened. There are some
Nutrition At present, Food Safety and Standards Authority of India (FSSAI), of Ministry
of Health and Family Welfare, established under the Food Safety and Standards
Act, 2006, is the regulating body related to food safety. FSSAI is responsible for
setting standards for food. e.g.
 Framing of regulations to lay down food safety standards
 Laying down guidelines for accreditation of laboratories for food testing
 Providing scientific advice and technical support to the Central Government
 Collecting data about food consumption, contamination, emerging risks etc
 Disseminating information and promoting awareness about food safety.
Consumers can connect to FSSAI through various channels. Recently an online
platform called ‘Food Safety Voice’ has been launched which helps consumers
to register their complaints and feedbacks about food safety issues related to
adulterated food, unsafe food, substandard food, labelling defects in food and
misleading claims and advertisements related to various food products.

5.5.4 Five Keys to Safer Food

i) Keep Clean
 Wash your hands before handling food and often during food preparation
 Wash your hands after going to the toilet
 Wash and sanitise all surfaces and equipment used for food
preparation
 Protect kitchen areas and food from insects, pests and other animals

Hand washing is important:

Dangerous microorganisms are widely found in soil, water, animals and people
and these microorganisms are carried on hands, wiping cloths and utensils.
Hands frequently transport microorganisms from one place to another, hand
washing is thus very important.
Hands should be washed before handling food and often during food
preparation; before eating; after going to the toilet; after handling raw meat
and poultry; after changing baby’s nappy, after blowing nose; after handling
rubbish and also chemicals; after playing with pet animals; after smoking
etc.
Hand washing method: Wet hands under running water; rub hands together
for 20 seconds with soap; rinse hands under running water; dry hands
thoroughly with dry clean towel. While washing hands pay attention to finger
tips / nails, thumbs, wrists, and in between fingers. Fig. 5.4

ii) Separate raw and cooked food

 Separate raw meat, poultry and seafood from other foods
 Use separate utensils, knives and cutting boards for handling raw
foods
 Store food in containers to avoid contact between raw and prepared
foods
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iii) Cook thoroughly Food Borne Diseases and
Food Safety
 Cook food thoroughly, especially meat, poultry, eggs and seafood
 Bring foods like soups / stews to boiling to make sure 70°C temperature
 Reheat cooked food thoroughly
iv) Keep food at safe temperatures

Fig. 5.4: Method of hand washing

 Do not leave cooked food at room temperature for more than 2 hours
 Refrigerate promptly all cooked and perishable food (preferably below
5°C)
 Keep cooked food piping hot (more than 60°C) prior to serving
 Do not store food too long even in the refrigerator
 Do not thaw frozen food at room temperature

What are safe temperatures for food?

Microorganisms cannot multiply if it is too hot or too cold. Cooling or freezing
does not kill microorganisms, rather limits growth.
The “danger zone” is temperature range of 5°C to 60°C in which
microorganisms multiply very fast. Storing food below or above the “danger
zone” can effectively limit the production of toxins.

v) Use safe water and raw materials

 Use safe water or treat it to make it safe
 Select fresh and wholesome foods
 Choose foods processed for safety, such as pasteurized milk 123
Nutrition  Wash fruits and vegetables, especially if eaten raw
 Do not use food beyond its expiry date

5.6 FOOD STORAGE, FOOD HANDLING AND

COOKING
Food born diseases are mainly caused due to unhygienic practices while cooking,
handling and storing the food items. Let’s now discuss about the general
principles of safe storage of food items, role of the food handlers in keeping
the food safe and wholesome and the essentials steps to be followed in safe
cooking practices.

5.6.1 General Principles of Safe Storage of Food Items

 Chemicals and cleaning supplies like detergents, soap bars, repellents are
stored away from food.
 Non-vegetarian and vegetarian products are kept physically separated or stored
in different containers / racks / compartments.
 Raw materials are kept separately with proper labelling from semi processed
and processed (cooked) foods.
 All foods are stored off the floor and away from the walls (atleast 6 inches).
Management of stored items
The principles of FIFO (first in first out) and FEFO (first expiry first out) should
be applied in management of stored food items. For items without a label
containing date of expiry of best before date, the rule of FIFO is followed. This
ensures that the food that has been in store the longest is used first. As food is
used, new food is added to the store to replace it; the essential of good storage
is to use the oldest food as soon as possible so that nothing is in store too long
lest it becomes unsafe to eat. Every storage area should have such a stock
rotation policy. For example, when two kgs onions are lying in the storage
area, if another five kgs are received then, put the recently received ones behind
the onions already in store. Ensure to use the previous ones first. For products
having a label containing date of expiry or best before date follow the principle
of FEFO. Items with closest expiry date should be used first even if they are
delivered later. Remove and return /destroy from store all products whose shelf
life has expired.

5.6.2 Role of Food Handlers in Food Borne Diseases

Most of us equate cooks as food handlers. However, the term food handler includes
all those involved in various stages / activities related to preparation, processing,
cleaning and chopping raw food material / vegetables, processing (peeling, de
skinning, cutting, soaking, marinating), kneading of flour, chapati making, boiling/
frying/sauté, washing of dirty utensils cooking and serving of food, e.g. waiter
staff/ service staff, chefs, head cooks, dishwashers, receiving and store room
staff, bartenders, host/hostesses who handle food, street vendors who sell food
items, house maids. Food handlers can cause as well as prevent food borne
diseases. (Fig. 5.5)
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Nutrition identifiable clinico-epidemiological characteristics. Immediate public health
responses include – early detection and assessment for severity; management,
referral and notification. All outbreaks should also be investigated.
Food safety is the present-day priority concern. Besides implementation and
monitoring of legislative and regulatory mechanisms at various levels, food safety
education is a critical pre-requisite. Food handlers at all levels and the community
should be made aware about practising five keys to safer food – Keep clean;
Separate raw and cooked food; Cook thoroughly; Keep food at safe temperatures;
and Use safe water and raw materials. Primary and mid-level health workers at
the field can really make a difference in this regard.

5.8 MODEL ANSWERS

Check Your Progress 1
1) 40%
2) Food-borne infections and food-borne intoxications
3) Bacteria, Virus, Parasites, Toxins and Chemicals,
4) Abdominal cramps, diarrhoea (which may be bloody), nausea, vomiting, fever,
headache, fatigue, and body aches.
Check Your Progress 2
1) C) - Secondary cases are common
2) Mustard oil contamination with argemone oil
3) Lathyrism
4) C) – Botulism
5) Diarrhoea, Nausea / Vomiting, Abdominal cramps, Fever
6) Food production and processing, food preparation and handling, improper
storage of food.
Check Your Progress 3
1) ‘Article of food whose nature, substance or quality is so affected as to render
it injurious to health’
2) 1. Keep clean; 2. Separate raw and cooked food; 3. Cook thoroughly; 4.
Keep food at safe temperatures; 5. Use safe water and raw materials.
3) Food Safety and Standards Authority of India (FSSAI)
4) Temperature range of 5°C to 60°C
5) At least 20 seconds

5.9 REFERENCES
1) Park K. Park’s Text Book of Preventive and Social Medicine. 23rd Edition.
Jabalpur: Benarasi Das Bhanot; 2015.
2) Government of India, Director General of Health Services. CD Alert: Monthly
News Letter of National Centre for Disease Control 2009; 13 (4).
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3) WHO. Five keys to safer food manual. Available from: www.who.int/ Food Borne Diseases and
foodsafety/publications/consumer/manual_keys.pdf. Food Safety

4) Food Safety Standards Authority of India. Key aspects to ensure food safety.
Available from: http://www.fssai.gov.in/TRAINING MANUAL.aspx
5) Dudeja P , Kaur S and Singh AJ. Food handlers - A crucial link in food
safety.New Delhi,New Era International Imprint, 2013.
6) Dudeja P Singh AJ and Kaur S (Editors). Food Safety Implementation- From
Farm to Fork. New Delhi, CBS Publishers & Distributors Pvt Ltd, 2016.
7) R K Gupta, P Dudeja & A S Minhas(Editors). Food Safety in 21st Century:
Public Health Perspective. Elsevier Publications,New York, Academic Press;
2017.

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